Department of Obstetrics and Gynaecology, Rahima Moosa Mother and Child Hospital, Johannesburg, Gauteng, South Africa; Department of Obstetrics and Gynaecology, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa.
Women's Health and HIV Research Group, Department of Obstetrics and Gynecology, School of Clinical Medicine, Faculty of Health Sciences, University of Kwa Zulu-Natal, Durban, South Africa.
Best Pract Res Clin Obstet Gynaecol. 2024 Jun;94:102473. doi: 10.1016/j.bpobgyn.2024.102473. Epub 2024 Feb 15.
Preeclampsia (PE) is a complex heterogeneous disorder with overlapping clinical phenotypes that complicate diagnosis and management. Although several pathophysiological mechanisms have been proposed, placental dysfunction due to inadequate remodelling of uterine spiral arteries leading to mal-perfusion and syncytiotrophoblast stress is recognized as the unifying characteristic of early-onset PE. Placental overgrowth and or premature senescence are probably the causes of late-onset PE. The frequency of PE has increased over the last few decades due to population-wide increases in risk factors viz. obesity, diabetes, multifetal pregnancies and pregnancies at an advanced maternal age. Whilst multimodal tools with components comprising risk factors, biomarkers and sonography are used for predicting PE, aspirin is most effective in preventing early-onset PE. The incidence and clinical consequences of PE and eclampsia are influenced by socioeconomic and cultural factors, therefore management strategies should involve multi-sector partnerships to mitigate the adverse outcomes.
子痫前期 (PE) 是一种复杂的异质性疾病,具有重叠的临床表型,这使得诊断和管理变得复杂。尽管已经提出了几种病理生理机制,但由于子宫螺旋动脉重塑不足导致灌注不良和合体滋养层应激,胎盘功能障碍被认为是早发型 PE 的统一特征。胎盘过度生长和/或过早衰老可能是晚发型 PE 的原因。由于肥胖、糖尿病、多胎妊娠和高龄产妇等危险因素在人群中广泛增加,过去几十年 PE 的发病率有所增加。虽然具有危险因素、生物标志物和超声成分的多模态工具用于预测 PE,但阿司匹林在预防早发型 PE 方面最有效。PE 和子痫的发生率和临床后果受到社会经济和文化因素的影响,因此管理策略应涉及多部门伙伴关系,以减轻不良后果。